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Skip Navigation LinksHome » Health Benefit Info Active » Dental  
 

General Information
The Fund has contracted with Delta Dental of Illinois (Delta Dental) for access to the Delta Dental PPO and Premier networks. The name of your plan is the Chicago Regional Council of Carpenters Welfare Fund. Your Delta Dental Group # is 20203. Refer to Group #20203 when calling Delta Dental or filing claims with them. Delta Dental’s extensive network of dental providers gives you many choices and typically lower costs. The Plan pays as follows:

 

Delta Dental PPO

Delta Dental Premier

Out-of-Network

Annual Maximum Benefit

$1,500

$1,500

$1,500

Annual Deductible (applies only to Basic and Major Care)

$50/Person

$100/Family

$50/Person

$100/Family

$50/Person

$100/Family

Balance Billing (The difference between the dentist's actual charge and the amount allowed by Delta Dental.)

Does not apply

Does not apply

Applies.  A Covered Individual is responsible for charges exceeding Delta Dental's maximum plan allowance

·     Preventive/Diagnostic Care (1)

 

 

 

o   Covered Individual through Age 18 (not subject to the Annual Deductible or Annual Maximum)

Paid at 100% of Delta Dental's PPO reduced schedule

 

Paid at 100% of Delta Dental's maximum plan allowance

 

Paid at 100% of Delta Dental's maximum plan allowance

o   Covered Individual - Ages 19 and older

 

Paid at 100% of Delta Dental's PPO reduced schedule

Paid at 100% of Delta Dental's maximum plan allowance

Paid at 100% of Delta Dental's maximum plan allowance

·        Basic Care (2) (All Ages)

Paid at 80% of Delta Dental's PPO reduced schedule

Paid at 80% of Delta Dental's maximum plan allowance

Paid at 80% of Delta Dental's maximum plan allowance

·        Major Care (3) (All Ages)

 

Paid at 80% of Delta Dental's PPO reduced schedule

Paid at 80% of Delta Dental's maximum plan allowance

Paid at 80% of Delta Dental's maximum plan allowance

·        Orthodontia

 

 

 

o   Dependent Children through Age 18

 

When services are rendered by a Delta Dental provider, the first $4,000 in orthodontia charges are paid at 50%. The remaining charges are paid at 25%.  If you met the $2,000 lifetime maximum benefit that was in effect prior to 07-01-2011, all subsequent orthodontia payments will be paid at 25%.

Paid at 80% of the dentist's usual fee subject to a Lifetime Maximum of $2,000

   o   Adults - Ages 19 and older  (subject  to a Lifetime Maximum of $2,000)

 

Paid at 80% of Delta Dental's PPO reduced fee schedule

Paid at 80% of the dentist's usual fee

Paid at 80% of the dentist's fee

 

(1)     Preventive/Diagnostic Care includes:

 

  • Oral Evaluations (two in a 12-month period)
  • Prophylaxis/Cleaning (two in a 12 month period)
  • X-rays (bitewings two in a 12 month period; full mouth or panoramic once in 36 month period; cephalometric once in a 24 month period)
  • Fluoride Treatment (once in a 12 month period for dependent children through age 18)
  • Palliative Treatment
  • Sealants (1st & 2nd Molars only, for dependent children through age 14)

 

(2)     Basic Care includes: 

 

  • Fillings
  • Oral Surgery
  • General Anesthesia
  • Periodontics
  • Endodontics
  • Consultations
  • Space Maintainers
  • Removal of cysts & tumors in the mouth
 
 

 

(3)     Major Care includes (services are covered once in a 5 year period, to the day) include:

 

  • Crowns, Jackets & Case Restoration
  • Fixed & Removable Bridges
  • Partial & Full Dentures
  • Veneers (Permanent Teeth Only)
  • Implants and related services

 

Note:  All Frequency limitations listed above are to the day. 

 

Is Your Dentist A Network Provider?
Visit Delta Dental of Illinois’ website at www.deltadentalil.com to find out. To obtain a list of providers in your area, click on “Find a Network Dentist” and select a network. Remember, your Plan gives you access to both the PPO and Premier networks. Add your city and state or zip code and pick your mileage limitation (i.e. less than 5 miles). You may also add additional criteria, such as a provider’s specialty, or a specific name. You can also call 1-800-323-1743 between 7:00 am and 7:00 pm CST to speak to a Delta Dental representative. The name of your plan is the Chicago Regional Council of Carpenters Welfare Fund. Your Delta Dental Group # is 20203. 

Filing a Claim for Benefits
All claims for dental services must be filed directly with Delta Dental of Illinois. Many network providers file electronically. Mail paper claims to: Delta Dental of Illinois, P.O. Box 5402, Lisle, IL 60532. Refer to Group #20203.

Appliances made for TMJ and Bruxism (Occlusal), including their Adjustments, and Snore Guards
The Plan covers appliances for TMJ and Bruxism, including their adjustments, and snore guards under the Comprehensive Medical Benefit as follows: 

Temporomandibular Joint Care (TMJ) BCBS PPO Provider Out-of-Network Provider
  • Physician and Therapy Services
  • Appliances, and their adjustments, for TMJ and Bruxism (Occlusal)
80% paid by Plan 60% paid by Plan
80% paid by Plan for an appliance once every 3 consecutive years, subject to the Non-PPO Calendar Year Deductible
Appliances limited to 2x lifetime no less than 3yrs apart.
 
After a Covered Individual has exhausted his/her $1,500 calendar year maximum dental benefit, the Plan covers repair of teeth due to an accidental injury (not work related) under the comprehensive medical portion of the Plan. The patient must provide proof of accidental injury and must have been eligible for benefits at the time of injury. Patient must provide proof that the dental benefits are exhausted. Not applicable to the Low Cost Plan.
 

 

 

 
 

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